[Factors related to loss of residual renal function in peritoneal dialysis].
Residual renal function (RRF) contributes to the quality of life of patients on dialysis through the better solutes clearances, fluid removal, less degree of anemia, better calcium-phosphorus control, better nutrition and removal of other uremic toxins. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient survival. This review studies the factors that contribute to the reduction or loss of RRF in PD patients and the medical measures to avoid it. The decline of RRF has been associated with age, inflammation/nutrition status, peritonitis rate, renal function and transport type at PD initiation, ESRD aetiology, and associated comorbidity. Cardiovascular disease before and during PD has been related with loss of RRF. Volume overload and high blood pressure on one side, and dehydration and some drugs on the other side, can facilitate the decline of RRF. Use of antihypertensive agents as angiotensin- converting enzyme inhibitors and angiotensin receptor blockers could preserve RRF. Still is on debate the influence of PD modality (manual or automated), with some more arguments for better preservation with continuous ambulatory PD. The employ of more biocompatible solutions seems to have a positive effect on RRF, but more evidence is still needed. Avoiding the mentioned factors and applying preventive measures we can preserve RRF and increase the well-being of PD patients.
Coronel
F
F
Servicio de Nefrología Hospital Clínico San Carlos, 28040 Madrid. fcoronel.hcsc@salud.madrid.org
Pérez Flores
I
I
D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D010530:Peritoneal Dialysis / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate